Friberg Ingrid K, Walker Neff
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Glob Health. 2014 Dec;4(2):020412. doi: 10.7189/jogh.04.020412.
Integrated community case management (iCCM) has been recommended by the World Health Organization to reduce mortality among children in populations with limited access to facility-based health care providers. Although many countries have introduced iCCM, interpretation of the impact is difficult due to many other activities occurring in the community. This paper suggests a method for using the Lives Saved Tool to model the independent impact of iCCM on child mortality.
The Lives Saved Tool (LiST) is a multi-cause model of mortality which allows users to look at the potential impacts of one or many interventions on one or many causes of death without double counting their impact. LiST uses changes in intervention coverage and cause-specific effectiveness estimates on mortality and risk factors to model overall changes in mortality as well as to attribute mortality reduction to specific interventions. Collecting data on the source of the care seeking behaviors is critical to being able to model and interpret the changes observed.
The complexity of implementation of iCCM in the environment of broader health changes requires modeling to understand the program specific impacts. Using LiST results as additional data in combination with observed coverage change and mortality reduction can help explain the isolated impact of a given iCCM program when other changes are ongoing. LiST is unable to determine why the changes in health care seeking behaviors occur, but can be useful in helping to explain whether or not the changes were beneficial.
世界卫生组织已推荐实施社区综合病例管理（iCCM），以降低在难以获得机构医疗服务提供者的人群中儿童的死亡率。尽管许多国家已引入iCCM，但由于社区中还存在许多其他活动，因此很难解读其影响。本文提出了一种使用“挽救生命工具”来模拟iCCM对儿童死亡率独立影响的方法。
“挽救生命工具”（LiST）是一种多病因死亡率模型，它允许用户查看一种或多种干预措施对一种或多种死因的潜在影响，而不会重复计算其影响。LiST利用干预覆盖率的变化以及针对死亡率和风险因素的特定病因有效性估计值，来模拟死亡率的总体变化，并将死亡率降低归因于特定干预措施。收集有关寻求医疗行为来源的数据对于能够模拟和解读观察到的变化至关重要。
在更广泛的健康变化环境中实施iCCM的复杂性需要通过建模来了解该项目的具体影响。当其他变化正在进行时，将LiST结果作为额外数据与观察到的覆盖率变化和死亡率降低相结合，有助于解释特定iCCM项目的单独影响。LiST无法确定寻求医疗行为发生变化的原因，但有助于解释这些变化是否有益。
